【摘要】 目的:参考血管内超声(IVUS)测量结果,分析定量血流分数(QFR)在评估冠状动脉(冠脉)造影临界病变中的诊断价值。方法:连续筛选南京医科大学第一附属医院2014年1月至2015年1月行冠脉造影的患者,纳入造影诊断冠脉临界病变(靶病变血管狭窄程度40%～70%)、并行IVUS检查的患者57例,共62处病变。使用QFR测量系统对入选的冠脉病变进行分析,参照IVUS测量的最小管腔面积(IVUS-MLA)及面积狭窄率(IVUS-AS)结果,分析冠脉造影临界病变中QFR对血管显著狭窄病变的诊断价值。结果:57例患者的平均靶病变IVUS-MLA为(3.93±1.15)mm~2,IVUS-AS为63.5%±11.8%,IVUS诊断的血管显著狭窄靶病变38例(61.3%);靶病变平均QFR为0.87±0.14。QFR与IVUS-MLA(R=0.477)呈中等程度正相关,与IVUS-AS(R=-0.604)呈较强负相关(P均<0.001)。相比QFR>0.8的冠脉造影临界病变,QFR≤0.8的病变IVUSMLA更小[(3.04±0.52)mm~2 vs.(4.15±1.16) mm~2,P<0.001],IVUS-AS更高(76.03%±5.65%vs. 60.19%±10.79%,P<0.001)。分别以IVUS-MLA<4 mm~2、IVUS-AS>70%诊断血管显著狭窄病变时,QFR的ROC曲线下面积分别为0.822(95%CI:0.717～0.926,P<0.001)和0.746(95%CI:0.617～0.876,P=0.001),以QFR≤0.8作为诊断界值,诊断一致性Kappa值分别为0.246(95%CI:0.085～0.407,P=0.007)和0.469(95%CI:0.246～0.692,P<0.001),敏感度分别为32.4%和47.8%,特异度分别为96.0%和94.9%,阳性预测值分别为92.3%和84.6%,阴性预测值分别为49.0%和75.5%。结论:QFR对冠脉造影临界病变中管腔面积显著狭窄的病变具有良好的诊断价值。更多还原

【Abstract】 Objectives:We aimed to analyze the diagnostic value of quantitative flow ratio(QFR) derived from intravenous ultrasound(IVUS) in defining intermediate coronary stenosis initially defined by coronary angiography.Methods: We consecutively enrolled 57 patients with a total of 62 coronary intermediate lesions diagnosed by coronary angiography(defined as visual-estimated vessel diameter stenosis of 40% to 70%) in the First Affiliated Hospital of Nanjing Medical University from January 2014 to January 2015. IVUS measurements data were obtained to determine the lumen stenosis. QFR analyses were conducted in all the selected lesions. According to minimal lumen area(MLA) and area stenosis(AS) assessed by IVUS, the performance of QFR on predicting lumen stenosis of the intermediate lesions initially diagnosed by coronary angiography was evaluated.Results: Of the 62 selected lesions, the mean IVUS-MLA was(3.93±1.15) mm~2 and mean IVUS-AS was 63.5%±11.8%, and QFR was 0.87±0.14. 38(61.3%) of the selected lesions were diagnosed as significant lumen stenosis by IVUS measurement. There was a moderate correlation between QFR and IVUS-MLA(R=0.477, P<0.001), and a strong correlation between QFR and IVUSAS(R=-0.604, P<0.001). Compared with the lesions with QFR>0.8,IVUS-MLA was significantly lower([3.04±0.52] mm~2 vs. [4.15±1.16] mm~2, P<0.001) and IVUS-AS was significantly higher(76.03%±5.65% vs. 60.19%±10.79%, P<0.001)in lesions with QFR≤0.8. When defining IVUS-MLA < 4 mm~2 as significant lumen stenosis, the area under the ROC curve regarding QFR was 0.822(95%CI: 0.717-0.926, P<0.001). When defining QFR≤0.8 as the diagnostic threshold, the consistency Kappa value was 0.246(95%CI: 0.085-0.407, P=0.007), the sensitivity was 32.4%, the specificity was 96.0%, the positive predictive value(PPV) was 92.3%, and the negative predictive value(NPV) was 49.0%. When defining IVUS-AS > 70% as significant lumen stenosis, the area under ROC curve regarding QFR was 0.746(95%CI: 0.617-0.876, P=0.001). When defining QFR≤0.8 as the diagnostic threshold,the consistency Kappa value was 0.469(95%CI: 0.246-0.692, P<0.010), the sensitivity was 47.8%, the specificity was 94.9%, the PPV was 84.6%, and the NPV was 75.5%.Conclusions: Predictive value of QFR is high on defining intermediate coronary lesions with significant lumen stenosis.更多还原